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Herbert Chen

Publications and source records attributed to Herbert Chen.

At least 37 records · Page 2Linked to original sources
PubMed2006

The Raf-1 pathway: a molecular target for treatment of select neuroendocrine tumors?

Neuroendocrine (NE) tumors such as medullary thyroid cancer, carcinoid, small cell lung cancer and pheochromocytoma are metastatic in nature, and secrete biogenic amines and hormones. In this review, we will discuss the possibility that activation of the Ras/Raf signaling pathway may be a therapeutic target for patients with select NE tumors. In-vitro activation of Raf-1 in NE tumors either by expression of the ectopic catalytic domain of Raf-1 or by a pharmacologic drug, ZM336372, resulted in growth inhibition. In addition, activation of the Ras/Raf pathway led to a significant reduction in NE markers such as serotonin, chromogranin A and calcitonin. These data support development of Raf-1-activating compounds for treatment of patients with NE tumors of selective subtypes.

Antineoplastic Agents↗
PubMed2006

In-vivo activation of Raf-1 inhibits tumor growth and development in a xenograft model of human medullary thyroid cancer.

Apart from surgical resection, there are no effective therapies for medullary thyroid cancer, a neuroendocrine tumor derived from parafollicular C cells. We have previously shown that activation of raf-1 in TT-raf cells by estradiol suppresses tumor cell growth and calcitonin secretion in vitro. TT-raf cells are a human medullary thyroid cancer cell line that contains an estrogen-inducible raf-1 construct. The in-vivo effects of raf-1 activation in this cell line, however, have not been characterized. Therefore, we utilized TT or TT-raf cells in a murine subcutaneous xenograft model to study tumor development and growth. Activation of raf-1, in mice with TT-raf tumors, led to a significant decrease in medullary thyroid cancer tumor formation. Control groups, however, had a high rate of medullary thyroid cancer tumor development. These data indicate that raf-1 activation by estradiol treatment in this TT-raf xenograft model inhibited tumor development. Furthermore, to determine whether raf-1 activation could also inhibit the growth of established tumors, estradiol and control pellets were implanted after tumor development. The TT-raf group that received estradiol pellets showed an 8-fold decrease in tumor volume compared with the TT-raf control group. Taken together, these results suggest that in-vivo activation of raf-1 in a murine model of medullary thyroid cancer not only led to a reduction in tumor development, but also inhibited the growth of established tumors. These results suggest that strategies to activate the raf-1/MEK/ERK1/2 signaling pathway may be a viable approach to treat patients with metastatic medullary thyroid cancer.

Animals↗
PubMed2006

Treatment of advanced carcinoid tumors.

PURPOSE OF REVIEW: Carcinoid tumors often present with metastatic disease. Generally, these tumors can be treated conservatively. New evidence exists, however, that stage IV disease may be better managed with more aggressive medical and surgical treatment. Headway is also being made into understanding the associated fibrosis seen with advanced disease and in better understanding signaling pathways with the hope of offering future treatment options. RECENT FINDINGS: Recent literature has advocated for more aggressive surgical treatment of carcinoid tumors, especially in the setting of hepatic metastases and peritoneal carcinomatosis. Octreotide and lanreotide are further being described for treating metastatic carcinoids. Radiolabeled somatostatin analogues may prove to be as effective for treating carcinoids as for visualizing them. Other potential treatment modalities include pharmacologic activation of signaling pathways to control excess hormone production. Research into fibrosis - a cause of pain, bowel obstruction, retroperitoneal vascular constriction and right heart failure - has shown that serotonin and tachykinins may be the key mediators. SUMMARY: Patients with stage IV carcinoid tumors may benefit from more aggressive surgical management and new treatment modalities. The growing body of knowledge regarding important molecular signaling pathway may lead to new medical therapies and further understanding of the sequelae of excess hormone production.

Antineoplastic Agents, Hormonal↗
PubMed2006

The need for intraoperative parathyroid hormone monitoring during radioguided parathyroidectomy by video-assisted thoracoscopy (VATS).

PURPOSE: We report on a patient with primary hyperparathyroidism (1HPT) who had a preoperative Tc-99m sestamibi scan localizing a single parathyroid adenoma in the mediastinum. METHODS: On removal of this hyperfunctioning adenoma by radioguided video-assisted thoracoscopic surgery (VATS), intraoperative PTH levels failed to decline in the appropriate manner consistent with curative resection. This prompted the surgical team to investigate further for a second adenoma, which revealed a 2 x 1-cm mass near the inferior border of the thyroid gland on the right lateral aspect of the trachea. RESULTS: In the absence of intraoperative PTH monitoring, the operation would have been terminated after the removal of the mediastinal adenoma, leading to an incomplete surgical resection and persistent 1HPT. CONCLUSION: In our patient, curative resection was obtained and a second operation was avoided because of the use of intraoperative PTH monitoring. This case also emphasizes that although VATS was planned, in treating patients with 1HPT, one must also be prepared to perform a neck exploration.

Aged↗
PubMed2005

Changing trends for surgery in elderly patients with hyperparathyroidism at a single institution.

BACKGROUND: Many elderly patients with primary hyperparathyroidism (1HPT), which increases in incidence with age and is frequently asymptomatic, are often not referred for surgery. However, the development of minimally invasive techniques has facilitated complex operations even in the elderly. Therefore, we sought to delineate the changes in the trends for surgical referral at our institution for patients over 70 years of age with 1HPT. METHODS: From January 1990 to March 2004, 422 patients underwent surgery for 1HPT at our institution. Of these, 98 were 70 years or older. In 2001, we introduced minimally invasive radioguided parathyroidectomy (MIRP). Patients were then analyzed based upon the availability of this technology (pre-MIRP era 1990-2000, and MIRP era 2001-2004). RESULTS: In the MIRP era, more elderly patients were referred for surgery when compared to the pre-MIRP era (30% versus 18%, P = 0.001). On average, 18 elderly patients/year had parathyroid surgery in the MIRP era compared to only 4 elderly patients/year pre-MIRP, representing a 4.5-fold increase. Furthermore, there were significantly more patients undergoing parathyroidectomy who were asymptomatic from 1HPT during the MIRP era (14% versus 2%, P < 0.001). Importantly, patients who underwent surgery in the MIRP era had a higher cure rate, lower complication rate, and shorter hospital stay. CONCLUSIONS: Since the introduction of MIRP at our institution, there has been an increase in the number of elderly patients with 1HPT referred for surgery as well as the proportion with only mild disease. Furthermore, there have been improvements in elderly patient outcomes during this time. MIRP is one of several factors that have led to an increase in elderly patients undergoing surgery for 1HPT.

Age Factors↗
PubMed2005

How should medical student surgical rotations be structured to optimize education?

BACKGROUND: Surgical rotations for medical students have traditionally been service-based, with students observing surgical cases in an area of concentration specific to their assigned service. This may result in a lack of exposure to other surgical fields. To overcome this problem, students may rotate through focused "mini-rotations" in surgical subspecialties. We evaluated improvements in knowledge for students exposed to the two following types of surgical education: (1) traditional service-based rotations and (2) focused mini-rotations in a surgical subspecialty. METHODS: Third-year medical students (n = 281) were assigned to a 4-week rotation on one of three services, with students on one service having a focused exposure to endocrine surgery. General surgical services included (1) surgical oncology/endocrine, (2) trauma, and (3) general surgery. In addition, all students were required to do a "mini-rotation" on vascular surgery for 2 days. To determine if there was a difference in learning between service-based (endocrine) versus mini-rotation-based (vascular) approaches to surgical education, a pre- and postrotation endocrine/vascular exam was administered. RESULTS: Students with exposure to endocrine surgery had a 2-fold improvement in endocrine exam test scores (P = 0.001) compared to students on other general surgery services. There was no difference in vascular exam scores between students on different surgical rotations, reflecting the fact that all students had exposure to vascular surgery. CONCLUSION: Service-based rotations can lead to disproportionate learning experiences due to variations in exposure. "Mini-rotations" appear to equalize learning opportunities by providing all students with exposure to surgical subspecialties. These results suggest that educational experiences may be maximized by incorporating focused mini-rotations in surgical subspecialties.

Education, Medical, Undergraduate↗
PubMed2005

A mouse model of carcinoid syndrome and heart disease.

BACKGROUND: Carcinoid heart disease occurs in over 65% of patients with the carcinoid syndrome and is characterized by fibrous thickening of cardiac valves, leading to heart failure. Whether serotonin is directly responsible for these cardiac abnormalities is unknown. Therefore, to further understand the etiology and pathophysiology of carcinoid heart disease, we developed an animal model of the carcinoid syndrome. MATERIALS AND METHODS: Seventeen nude mice underwent intrasplenic injection of human pancreatic carcinoid BON cells (10(7)) and then were euthanized 9 weeks later. Murine livers were analyzed by immunohistochemistry. Murine hearts were sectioned and the surface area of the right heart valves determined. Blood was also collected and analyzed for platelet serotonin by ELISA. RESULTS: Sixty-five percent of the mice developed gross carcinoid liver metastases demonstrated by chromogranin-A-staining lesions within the liver. Mice with carcinoid liver metastases had elevated platelet serotonin levels (1058 +/- 529 ng/ml versus 123 +/- 52 ng/ml, P = 0.002) when compared to the controls. Animals with carcinoid liver metastases also had a trend toward greater tricuspid valvular surface areas (242 +/- 24 versus 174 +/- 25 microm, P = 0.08). On histological examination, this increase in tricuspid surface area in mice with liver metastases appeared to be due to fibrosis of the valvular tissues, consistent with the pathologic findings of carcinoid heart disease. CONCLUSIONS: Using this novel animal model of carcinoid syndrome, the tricuspid valve thickening resembling carcinoid heart disease could be due to exposure to factors such as serotonin secreted by carcinoid tumor cells.

Animals↗
PubMed2005

Regulation of neuroendocrine differentiation in gastrointestinal carcinoid tumor cells by notch signaling.

CONTEXT: Gastrointestinal (GI) carcinoid tumors elaborate serotonin and other vasoactive substances, causing the carcinoid syndrome. Based on developmental biology data, we hypothesized that basic helix-loop-helix transcription factors, including achaete-scute complex homolog-like 1 (Ascl1)/hASH1, and the Notch signaling pathway might regulate the neuroendocrine phenotype in GI carcinoids. OBJECTIVE: The aim of this study was to evaluate expression of developmental transcription factors and Notch signaling components in GI carcinoids and model their interaction in a relevant GI carcinoid cell line. DESIGN: Fourteen GI carcinoid tumor specimens, five paired adjacent normal tissues, fetal tissues, and tumor cell lines were analyzed by RT-PCR and immunoblot. BON carcinoid cells were further analyzed after Notch overexpression for neuroendocrine marker expression, serotonin production, and growth. SETTING: The study was conducted in an academic referral center. PATIENTS OR OTHER PARTICIPANTS: Deidentified archival pathology specimens were examined. RESULTS: Among a panel of six developmental transcription factors tested, only Ascl1 mRNA was overexpressed compared with surrounding normal tissue (seven of 10 GI carcinoid tumors and in BON cells, none of five normal tissues). Ascl1 protein was also expressed in four of four carcinoid tumors and BON cells). Notch pathway ligands, receptors, and downstream effectors were widely expressed in tumor and normal specimens. Overexpression of activated Notch1 in BON cells led to induction of the Notch effector hairy and enhancer of split 1 (Hes1), loss of Ascl1, reductions in neuron-specific enolase, synaptophysin, and chromogranin A, and most significantly, an 89% decrease in serotonin concentration and equivalent reductions in serotonin-reactive cells and repression of tryptophan hydroxylase 1 mRNA. CONCLUSIONS: The Notch signaling pathway is a significant regulator of neuroendocrine differentiation and serotonin production in GI carcinoid tumors.

Basic Helix-Loop-Helix Proteins↗
PubMed2005

Radioguided thoracoscopic mediastinal parathyroidectomy with intraoperative parathyroid hormone testing.

BACKGROUND: Primary hyperparathyroidism is the leading cause of hypercalcemia in the United States. The goal of this study was to evaluate the feasibility of radioguided thoracoscopic mediastinal parathyroidectomy and intraoperative immunoreactive parathyroid hormone (iPTH) level testing to guide completeness of resection. METHODS: Mediastinal parathyroidectomy was performed thoracoscopically with intraoperative radioguidance using a hand-held gamma probe after injection of 10 mci of TC-99m sestamibi. Parathyroid excision was confirmed by ex vivo measurement of specimen radioactivity greater than 20% of background. Complete resection was confirmed by a greater than 50% decrease in serum iPTH level at 5 minutes postresection. RESULTS: Four patients had mediastinal parathyroid glands successfully localized and resected thoracoscopically. Mean weight of the excised parathyroid adenoma was 1,714 mg (range, 425 to 4,400 mg). Baseline iPTH levels decreased from a mean of 202 to 39 pg/dL 5 minutes postresection. One patient underwent radioguided resection of a second enlarged cervical parathyroid adenoma at the same setting when his intraoperative iPTH levels failed to fall below 50% of baseline, despite resection of a 440 mg mediastinal parathyroid gland. Median hospital stay was one day. All mediastinal parathyroid glands resected were confirmed adenomas on final histologic examination. All patients were normocalcemic at follow-up (mean, 25 months), indicating cure. CONCLUSIONS: Thoracoscopic mediastinal parathyroidectomy with intraoperative iPTH level monitoring is safe and effective. Radioguidance facilitates parathyroid localization. Ex vivo specimen radioactivity of greater than 20% of background confirms parathyroid resection and obviates the need for costly, time-consuming frozen section analysis. A 50% decrease in baseline iPTH level 5 minutes postresection confirms complete resection of parathyroid adenomas.

Calcium↗
PubMed2005

The role of intraoperative parathyroid hormone testing in patients with tertiary hyperparathyroidism after renal transplantation.

BACKGROUND: Intraoperative parathyroid hormone (PTH) testing has been shown to accurately define adequacy of parathyroid resection in patients with primary hyperparathyroidism (HPT) and alters the operative management in 10% to 15% of cases. However, the benefit of this technique in patients with tertiary HPT after renal transplantation undergoing parathyroidectomy is unclear. METHODS: Intraoperative PTH was measured in 32 consecutive patients undergoing parathyroidectomy for tertiary HPT after renal transplantation between March 2001 and November 2004 by using the Elecsys assay at baseline and, subsequently, 5, 10, and 15 minutes after curative resection. The outcomes of these patients were evaluated. RESULTS: All patients were cured after surgery. Of the 32 patients, 29 were found to have parathyroid hyperplasia, while 1 had a single adenoma and 2 had double adenomas. The average drop in intraoperative PTH levels after curative resection was 69 +/- 3.5% at 5 min., 77 +/- 2.3% at 10 minutes, and 83 +/- 3.4% at 15 minutes. PTH testing changed the intraoperative management in 5 (16%) patients. One patient with a single adenoma and 2 patients with double adenomas had a >50% drop at 10 minutes. after excision; therefore, the operation was terminated without further resection. Two patients did not have a >50% drop at 10 minutes after 3.5 gland resection. These patients were explored further, and additional supernumerary parathyroid glands were identified and resected. After resection of these additional glands, the PTH fell by >50%, indicating cure. CONCLUSIONS: In patients undergoing parathyroidectomy for tertiary HPT after renal transplantation, a decrease in intraoperative PTH levels >50% at 10 minutes after completion of the operation indicated adequate resection. Furthermore, intraoperative PTH testing altered the operative management in 16% of patients. Therefore, similar to its role in patients with primary HPT, intraoperative PTH testing appears to play an equally important role in the management of patients with tertiary HPT undergoing parathyroidectomy.

Female↗
PubMed2005

Hairy Enhancer of Split-1 (HES-1), a Notch1 effector, inhibits the growth of carcinoid tumor cells.

BACKGROUND: The Notch1-signaling pathway has been shown to regulate the differentiation and growth of carcinoid tumor cells. However, the molecules that mediate Notch1 signaling, as well as their potential roles in regulating the growth of carcinoid tumors, have not been characterized. We and others have shown previously that the transcription factor Hairy Enhancer of Split-1 (HES-1) is upregulated in response to Notch1 signaling, demonstrating that it is a Notch1 effector. We hypothesized that HES-1 may be the essential downstream factor in Notch1-mediated growth regulation of carcinoid tumors. METHODS: H727 carcinoid tumor cells were transduced stably with a doxycycline-inducible HES-1 construct, creating H727-HES-1 cells. H727-TRE (vector-only control) and H727-HES-1 cells were then treated with varying concentrations of doxycycline to achieve increasing levels of HES-1 protein expression. Cell proliferation was determined with the use of a cell viability assay. RESULTS: Treatment of H727-HES-1 cells with increasing dosages of doxycycline resulted in dose-dependent increases in HES-1 protein by Western blot analysis. Importantly, induction of HES-1 in carcinoid tumor cells led to suppression of tumor cellular proliferation. Moreover, the degree of carcinoid growth inhibition appeared to be proportional to the level of HES-1 induction. CONCLUSIONS: HES-1 alone can regulate the growth of carcinoid tumor cells. Furthermore, these results suggest that HES-1 may be the critical downstream effector in the Notch1-signaling pathway.

Basic Helix-Loop-Helix Proteins↗
PubMed2005

Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy.

BACKGROUND: Intraoperative parathyroid hormone (iPTH) testing often is used during minimally invasive parathyroidectomy for primary hyperparathyroidism (1 degrees HPT). However, several investigators report that these assays are not cost effective and do not improve outcomes significantly. METHODS: To determine the impact of iPTH testing on the outcomes of patients with 1 degrees HPT, we reviewed our experience. From January 1990 to June 2004, there were 345 consecutive patients with 1 degrees HPT and positive localization studies for a single parathyroid adenoma who were candidates for minimally invasive parathyroidectomy. Group 1 patients (n = 157) underwent parathyroid exploration without iPTH testing and group 2 patients (n = 188) had an operation with iPTH testing. RESULTS: Of the group 1 patients, 15 (10%) still were hypercalcemic postoperatively owing to additional unidentified hyperfunctioning parathyroid glands. In contrast, among 188 group 2 patients, 170 (90%) had resection of a single parathyroid adenoma, a greater than 50% decrease in iPTH levels, and were cured. The remaining 18 (10%) patients did not have an adequate reduction in iPTH levels and underwent bilateral neck exploration with resection of additional parathyroids. Of these 18 patients, 9 had double adenomas and 9 had 3- or 4-gland hyperplasia. Importantly, all patients in group 2 were cured. CONCLUSIONS: iPTH testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. iPTH testing allowed intraoperative recognition and resection of additional hyperfunctioning parathyroids missed by preoperative imaging studies. Consequently, we strongly advocate the routine use of iPTH testing in patients who undergo minimally invasive parathyroidectomy for 1 degrees HPT.

Adenoma↗
PubMed2005

Medullary thyroid cancer: the functions of raf-1 and human achaete-scute homologue-1.

Medullary thyroid cancer (MTC) is a prototypic neuroendocrine tumor of the thyroid C cells. Other than surgery, there are no curative therapies for MTC. In this review, we detail recent studies that suggest that targeting specific signaling pathways may be a viable strategy to control MTC tumor progression. Specifically, we discuss the role of the raf-1 and achaete-scute homologue-1 pathways in the MTC tumor growth and differentiation.

Animals↗
PubMed2005

A comprehensive evaluation of perioperative adjuncts during minimally invasive parathyroidectomy: which is most reliable?

OBJECTIVE: To determine the utility of several perioperative adjuncts for parathyroid localization during parathyroid surgery, we prospectively compared the accuracy of sestamibi-single photon emission computed tomography (SPECT) scanning, radioguided surgery, and intraoperative parathyroid hormone (ioPTH) testing. SUMMARY AND BACKGROUND DATA: Minimally invasive parathyroidectomy (MIP) is rapidly becoming the procedure of choice in patients with primary hyperparathyroidism (HPT). Several perioperative adjuncts can be used to localize parathyroid adenomas, including sestamibi-SPECT scanning, radioguided surgery, and ioPTH testing. However, the relative value of each of these technologies is unclear. METHODS: Between March 2001 through September 2004, 254 patients with primary HPT underwent parathyroidectomy. All patients had preoperative imaging studies and underwent radioguided surgery with a gamma probe and ioPTH testing. The use of each perioperative adjunct was determined based on the intraoperative findings. RESULTS: The mean age of patients was 61 +/- 1 year. The mean calcium and parathyroid hormone levels were 11.4 +/- 0.1 mg/dL and 136 +/- 6 pg/mL, respectively. Of the 254 patients, 206 (81%) had a single parathyroid adenoma, 28 (11%) had double adenomas, 19 (8%) had hyperplasia, and one had parathyroid cancer. All resected parathyroid glands were hypercellular (mean weight = 895 +/- 86 mg). The cure rate after parathyroidectomy was 98%. The positive predictive values for sestamibi scanning, radioguided surgery, and ioPTH testing were 81%, 88%, and 99.5%, respectively. CONCLUSIONS: This series is one of the largest to date that prospectively compares the use of sestamibi scanning, radioguided surgery, and ioPTH testing. Of all the perioperative adjuncts used during parathyroid surgery, ioPTH testing has the highest sensitivity, positive predictive value, and accuracy. Thus, the inherent variability of sestamibi scanning and radioguided techniques emphasizes the critical role of ioPTH testing during parathyroid surgery.

Adenoma↗
PubMed2005

Conservation of the Notch1 signaling pathway in gastrointestinal carcinoid cells.

Gastrointestinal (GI) carcinoid cells secrete multiple neuroendocrine (NE) markers and hormones including 5-hydroxytryptamine and chromogranin A. We were interested in determining whether activation of the Notch1 signal transduction pathway in carcinoid cells could modulate production of NE markers and hormones. Human pancreatic carcinoid cells (BON cells) were stably transduced with an estrogen-inducible Notch1 construct, creating BON-NIER cells. In the present study, we found that Notch1 is not detectable in human GI carcinoid tumor cells. The induction of Notch1 in human BON carcinoid cells led to high levels of functional Notch1, as measured by CBF-1 binding studies, resulting in activation of the Notch1 pathway. Similar to its developmental role in the GI tract, Notch1 pathway activation led to an increase in hairy enhancer of split 1 (HES-1) protein and a concomitant silencing of human Notch1/HES-1/achaete-scute homolog 1. Furthermore, Notch1 activation led to a significant reduction in NE markers. Most interestingly, activation of the Notch1 pathway caused a significant reduction in 5-hydroxytryptamine, an important bioactive hormone in carcinoid syndrome. In addition, persistent activation of the Notch1 pathway in BON cells led to a notable reduction in cellular proliferation. These results demonstrate that the Notch1 pathway, which plays a critical role in the differentiation of enteroendocrine cells, is highly conserved in the gut. Therefore, manipulation of the Notch1 signaling pathway may be useful for expanding the targets for therapeutic and palliative treatment of patients with carcinoid tumors.

Basic Helix-Loop-Helix Proteins↗
PubMed2005

ZM336372, a Raf-1 activator, suppresses growth and neuroendocrine hormone levels in carcinoid tumor cells.

Neuroendocrine tumors, such as carcinoids, are highly metastatic neoplasms that secrete bioactive hormones resulting in carcinoid syndrome. Few curative treatments exist outside of surgical resection. We have previously shown that activation of the Raf-1 signaling pathway can suppress hormone production in carcinoid tumor cells. In this study, we investigated a novel treatment for carcinoid tumor cell growth based on pharmacologic Raf-1 activation using the compound ZM336372. Treatment of carcinoid tumor cells with ZM336372 resulted in progressive phosphorylation of Raf-1, mitogen-activated protein kinase 1/2, and extracellular signal-regulated kinase 1/2. Importantly, exposure to ZM336372 resulted in a significant reduction of bioactive hormone levels as well as the transcription factor, human achaete-scute homologue-1 in carcinoid tumor cells. Furthermore, treatment with ZM336372 led to a marked suppression of cellular proliferation and induction of the cell cycle inhibitors p21 and p18. In summary, ZM336372 targets both proliferation and palliative issues associated with carcinoid tumor cells, and therefore, warrants further investigation as a possible therapeutic strategy for patients with carcinoid tumors.

Benzamides↗
PubMed2004

Why do students choose careers in surgery?

BACKGROUND: Recent changes in medical education have emphasized primary care careers. This could have a negative impact on the number of applicants to surgical residencies. We hypothesized that experiences during the third year surgical clerkship are influential for students' subsequent residency choice. MATERIALS AND METHODS: Third year medical students who completed their surgical clerkship in the 2001-02 academic year were surveyed pre- and post-surgical clerkship. Responses were analyzed and correlated to the 2003 match results. RESULTS: The response rate of students surveyed was 98% (82 surveys/83 match results). Pre-clerkship, 6/82 students (7%) expressed an interest in surgery or surgical subspecialty careers. Post-clerkship, 34/84 students (40%) expressed an increased interest a surgical career; 13/84 (15%) expressed a decreased interest, and 37% of students expressed no change in career interest. Of those students expressing an increased interest in surgery, the clerkship experiences most noted to be influential were (1) number of cases participated/scrubbed (95%), (2) resident interaction (85%), (3) faculty interaction (80%), and (4) number of cases observed (65%). The number of hours spent on rotation (call, rounds) was the leading experience associated with a decreased interest in a surgical career. 12/83 students surveyed (14%) ultimately matched into a surgical program (NRMP 2003 match results). CONCLUSIONS: These data suggest that operative exposure and interaction with residents and faculty have a positive influence in students' choice of a surgical career. Although only 6% of students expressed an interest in surgery pre-clerkship, a 2-fold increase in this number was noted in choice of residency (14%). Work hours were the primary negative indicator for surgery residency. As medical curriculum is restructured and surgical exposure decreased, these data underscore the importance of quality exposure to both procedures and role models during the 3rd year surgical clerkship.

Career Choice↗